Hospital Claims Processing

Hospital outpatient clinics that dispense EMEND and other oral antiemetics to their patients for prechemotherapy and postchemotherapy treatment of nausea and vomiting may bill Medicare Part B for the covered drugs on the UB-04 (CMS-1450) claim form.

See chart for changes in Medicare Outpatient Billing for EMEND.

> See a Sample UB-04 Form for Hospital Outpatient Clinic Billing

PLEASE NOTE: The UB-04 claim form replaced the UB-92 claim form. As of May 22, 2007, the UB-92 claim form is no longer accepted. See Medicare Claims Processing Manual (Pub 100-04), Chapter 25 for further information.

> Read Medicare Coverage Overview for EMEND

Hospital Billing of Take-Home Drugs

Effective July 1, 2006, CMS implemented a new policy on hospital outpatient billing for take-home oral antiemetics (CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Transmittal 840).

As a result:

• The trifold pack (NDC 0006-3862-03) can be billed in its entirety through the fiscal intermediary (FI). No supplying fee applies for drugs billed to the FI.
• The initial dose of EMEND that is dispensed during the outpatient visit will continue to be billed to the local FI.
• Hospitals that provide outpatient care and dispense more than a single day’s supply of EMEND for take-home use will need to bill the appropriate DME MAC for the take-home portion and the associated supplying fees. (Additional billing requirements and instructions will be provided by the DME MAC.)
• Supplying fees must be billed on the same claim as the drug.

EMEND is given for 3 days as part of a regimen that includes a corticosteroid and a 5-HT₃ receptor antagonist. The recommended dosage of EMEND is 125 mg orally 1 hour before chemotherapy treatment (day 1) and 80 mg once daily in the morning on days 2 and 3.

For information about Merck products or services, please call 866-448-7590. The Merck National Service Center will be pleased to assist you Monday through Friday from 8 AM to 7 PM ET.